Voices from the field: exploring service providers' insights into service delivery and AAC use in Canada.

Use of augmentative and alternative communication (AAC) often relies on the involvement of AAC service providers; however little is known about how AAC services are delivered across Canada. This study aimed to explore AAC service provision and factors influencing use of AAC from the perspectives of service providers across Canada who are involved in providing and/or supporting use of AAC systems. The 22 participants from nine (of the 10) provinces participated in online focus groups. Participants were speech-language pathologists, occupational therapists, communicative disorders assistants, and a teacher. Transcripts of the audio recordings were analyzed using reflexive thematic analysis. Four themes were generated that reflect service-related factors contributing to the use of AAC in Canada: Support of Organizational Structures, Concordant Relationships and Goals, Making the Right Decisions, and Influence of Knowledge and Attitudes. These themes highlight how government systems, key stakeholders, assessment practices, and knowledge of AAC influence service provision and use of AAC. Voices from across Canada highlighted shared experiences of services providers as well as revealed variability in service delivery processes. The findings bring to attention a need for further research and development of service provision guidelines to support consistency, quality in practice, and equity in AAC services.

Canadian manufacturer and technician perspectives on the design and use of augmentative and alternative communication technology.

PURPOSE: Device manufacturers and technicians (MaTs) of augmentative and alternative communication (AAC) systems play key roles in the design and successful uptake of communication devices. This study aims to investigate MaT perspectives on AAC device design and effective use. MATERIALS AND METHODS: To investigate their perspectives, a focus group of MaTs within Canada was conducted. Reflexive thematic analysis was used to analyze data. FINDINGS: Three major themes resulted from analysis, which reflect MaT's views: AAC hardware and software flexibility, AAC knowledge and implementation, and social good versus financial resources. CONCLUSIONS: This study provides insights into the complexities faced by MaTs in balancing technical support of system end-users and the financial resources necessary for that support. These insights indicate a need for increased financial resources and the expansion of individuals who qualify for AAC system candidacy. MaTs suggest that an increase in resources and candidacy could lead to more successful AAC implementation and a greater understanding of AAC for all stakeholders.

Augmentative and Alternative Communication (AAC):• AAC technology provides individuals with communication disabilities a form of alternative communication.• The success of AAC systems is dependent on multiple factors including AAC stakeholders, system design, and system implementation.• This study explores AAC manufacturers and technicians perspectives on how to make AAC systems as effective and widely accessible as possible.

Functional impact of augmentative and alternative communication scale: development of an outcome measure for educators of students with complex communication needs.

PURPOSE: The study aim was to develop and assess the measurement properties of the Functional Impact of Augmentative and Alternative Communication - Educator (FIAAC-E) scale - an educator-reported measure designed to detect change in factors associated with communicative participation in students who use augmentative and alternative communication (AAC). METHODS: The study had three phases. In phase 1 (content validity), 22 content specialists independently rated the relevancy of 22 dimensions proposed for the new scale. In phase 2 (item generation, face validity), 8 educators independently completed a preliminary version of the FIAAC-E scale and flagged items that were unclear. Next, these educators adjusted the wording of unclear items during consensus-building sessions. In phase 3 (item reduction, reliability, convergent validity), 62 educators completed an online survey that included the revised FIAAC-E scale. Survey data were used to shorten the scale, estimate its reliability, and evaluate support for its convergent validity. RESULTS: In phase 1, the 11 dimensions ranked most highly by content specialists were selected for inclusion in the preliminary scale. In phase 2, educators reviewed 113 items and revised 33 to improve clarity. In phase 3, correlational statistics informed the selection of 77 items for the shortened scale. Subsequent data analyses indicated acceptable levels of internal consistency and test-retest reliability and support for convergent validity of the preliminary measure. CONCLUSION: The study provides emerging evidence that supports the FIAAC-E scale as a reliable way to evaluate communicative participation in children and youth who use AAC systems at school.Implications for rehabilitationUsing a reliable means to measure the effectiveness of AAC for children and youth at school may reveal important factors that influence successful communicative, academic, and social participation in school.The FIAAC-E scale is a promising educator-reported questionnaire to inform the development of communication goals and monitor progress towards meeting these goals for students with complex communication needs.

Toward greater involvement of youth with complex communication needs in the selection of augmentative and alternative communication devices.

Purpose: The study aim was to examine the measurement properties of the Youth Evaluation of Products Scale for Augmentative and Alternative Communication (YEP-AAC) as a means to understand the product attitudes of youth toward their AAC devices.Methods: In study 1, four males and two females between the ages of 8 and 17 years (median age = 14 years) participated in face-to-face interviews. A researcher administered the YEP-AAC and then asked youths to explain the rationale for their item ratings. Two researchers analyzed masked transcripts of the interviews to predict the valence of item ratings assigned by youths. In study 2, 18 families participated in a mailed survey to examine the reliability and validity of the scale domains. Seventeen mothers/one father and their children (9 male/9 female) between the ages of 10 and 20 years participated (median age = 16 years).Results: The level of chance-corrected agreement between valences converted from youth ratings on the YEP-AAC and those assigned by researchers was fair (weighted kappa = 0.38). Internal consistencies of the scale domains were acceptable. Youths who rated their AAC devices more favourably had higher functional communication as hypothesized.Conclusion: The two studies provide support for the face validity, internal consistency and convergent validity of the YEP-AAC as a measure of the product attitudes of youth with complex communication needs.Implications for rehabilitationDeveloping reliable ways to understand the product needs, preferences and values of youth with complex communication needs will help to support the selection, acquisition and use of augmentative and alternative communication (AAC) devices.Consumer socialization helps to explain how youth may acquire the skills, knowledge and experience relevant to their role as AAC consumers.Reliable youth-report questionnaires that are grounded in consumer socialization provide an expedient way to understand the product attitudes of young consumers with complex communication needs.

Responsiveness of a parent-reported outcome measure to evaluate AAC interventions for children and youth with complex communication needs.

Evaluation of the effectiveness of augmentative and alternative communication (AAC) interventions requires reliable measures that are responsive to change. The aim of this study was to explore the potential of the Family Impact of Assistive Technology Scale for AAC (FIATS-AAC) to detect functional change in children and youth with AAC needs, aged 3-17 years, and their families, 6 and 12 weeks after receiving a graphic-based, speech-generating device (SGD). Parents whose children were awaiting a SGD as part of their regular AAC service participated in the study. In all, 45 parents completed the FIATS-AAC during each of three phone interviews: at the time of device delivery, and then 6 weeks and 12 weeks after receiving the device. Children and youth were aged 3-16 years (M = 7.8, SD = 3.3) and were mostly context-dependent communicators. Paired t-tests indicated statistically significant gains in functioning from baseline to both 6 and 12 weeks after receiving the AAC device. Effect sizes were 0.41 and 0.38, respectively. This study provides initial support for the ability of the FIATS-AAC to detect functional changes in children and youth and their families after receiving a graphic-based SGD.

A listening skill educational intervention for pediatric rehabilitation clinicians: A mixed-methods pilot study.

OBJECTIVE: To prepare for an RCT by examining the effects of an educational intervention on the listening skills of pediatric rehabilitation clinicians, piloting study procedures, and investigating participants' learning experiences. METHODS: Six experienced clinicians received the intervention, consisting of video simulations and solution-focused coaching regarding personal listening goals. Self- and observer-rated measures of listening skill were completed and qualitative information was gathered in interviews and a member checking session. RESULTS: Significant change on self-reported listening skills was found from pre- to post-test and/or follow-up. The pilot provided useful information to improve the study protocol, including the addition of an initial orientation to listening skills. Participants found the intervention to be a highly valuable and intense learning experience, and reported immediate changes to their clinical and interprofessional practice. CONCLUSION: The educational intervention has the potential to be an effective means to enhance the listening skills of practicing pediatric rehabilitation clinicians.

Developing authentic clinical simulations for effective listening and communication in pediatric rehabilitation service delivery.

PURPOSE: To describe the creation and validation of six simulations concerned with effective listening and interpersonal communication in pediatric rehabilitation. METHODS AND FINDINGS: The simulations involved clinicians from various disciplines, were based on clinical scenarios related to client issues, and reflected core aspects of listening/communication. Each simulation had a key learning objective, thus focusing clinicians on specific listening skills. The article outlines the process used to turn written scenarios into digital video simulations, including steps taken to establish content validity and authenticity, and to establish a series of videos based on the complexity of their learning objectives, given contextual factors and associated macrocognitive processes that influence the ability to listen. A complexity rating scale was developed and used to establish a gradient of easy/simple, intermediate, and hard/complex simulations. CONCLUSIONS: The development process exemplifies an evidence-based, integrated knowledge translation approach to the teaching and learning of listening and communication skills.

Towards Advancing Knowledge Translation of AAC Outcomes Research for Children and Youth with Complex Communication Needs.

The production of new knowledge in augmentative and alternative communication (AAC) requires effective processes to leverage the different perspectives of researchers and knowledge users and improve prospects for utilization in clinical settings. This article describes the motivation, planning, process, and outcomes for a novel knowledge translation workshop designed to influence future directions for AAC outcomes research for children with complex communication needs. Invited knowledge users from 20 pediatric AAC clinics and researchers engaged in the collaborative development of research questions using a framework designed for the AAC field. The event yielded recommendations for research and development priorities that extend from the early development of language, communication, and literacy skills in very young children, to novel but unproven strategies that may advance outcomes in transitioning to adulthood.

Development of a measure to assess effective listening and interactive communication skills in the delivery of children's rehabilitation services.

PURPOSE: Therapists' listening and communication skills are fundamental to the delivery of children's rehabilitation services but few measures comprehensively assess these skills. The 24-item Effective Listening and Interactive Communication Scale (ELICS) was developed to reflect a multifaceted conceptualization based on evidence in the literature. METHOD: Data from 41 pediatric rehabilitation therapists (occupational, physical, speech-language, recreation, and behavioural therapists; psychologists and social workers) were used to determine the factor structure, internal consistency, and construct validity of the subscales. RESULTS: The measure contains four subscales with very good to excellent reliability: Consensus-oriented, Exploratory, Receptive, and Action-oriented Listening. Content validity was ensured by the development process. CONCLUSIONS: The ELICS portrays listening as a purposeful, goal-oriented, and relational activity. The measure allows clinicians to assess and reflect on their listening/communication skills, and can be used to evaluate professional development activities and interventions geared to improving these skills.

Teamwork in AAC: examining clinical perceptions.

This study examines Prescription Review (PR), a model of teamwork practiced in Augmentative and Alternative Communication (AAC) centres in Ontario, Canada. PR is a process in which teams make decisions about AAC system recommendations. For this study, 92 out of 141 professionals working on AAC teams completed questionnaires measuring the benefits of PR. Findings suggest that PR is beneficial in the areas of learning, providing quality services, team support, and decision making. Participants reported satisfaction with the quality of treatment plan, the PR results, and process. Perceptions of PR were related to size of the teams, participants' years of experience, and the range of experience on teams. This study supports PR and highlights the importance of healthy working relationships.

Reliability of speech generating devices: a 5-year review.

Individuals who use augmentative and alternative communication (AAC) depend on technology to meet their daily needs and form relationships. Speech generating devices (SGDs) are integral components of communication systems. Reliability of SGDs is critical for effective use in everyday life. This study examined the reliability of new SGDs and found that mean time to first failure was 42.7 (SD = 41.2) weeks and at least 40% required repairs within the first year of use. The components that most frequently broke down were touch screens, wiring, main boards, batteries, memory cards, and AC adaptors. The costs of repairing SGDs were analyzed. The clinical implications of device breakdown are identified for key stakeholders, including clients, families, service providers, funding agencies, and manufacturers.

Measuring the quality of transdisciplinary teams.

The Team Decision Making Questionnaire (TDMQ) demonstrated internal consistency, stability over time, and construct validity. Internal consistencies were excellent and Cronbach's Alphas (N = 102) for the 4 components ranged from 0.83 to 0.91. The internal consistency for the total instrument was 0.96. Test re-test reliability (N = 22) measured with Intraclass Correlation Coefficient was good. Transdisciplinary teamwork is widely practiced in health care. However, specific measures to evaluate transdisciplinary team decision-making are not described in the literature. The purpose of this study was to develop and psychometrically test a scale to measure the quality of transdisciplinary teamwork. A multi-method approach using focus groups, field testing, and quantitative instrument development procedures was used to develop and evaluate TDMQ. Principal component analysis (PCA) with a varimax rotation (N = 102) revealed a four-component solution resulting in a 19-item measure consisting of 4 subscales including Decision Making, Team Support, Learning, and Developing Quality Services. This study's findings support the use of the TDMQ for measuring the benefits of transdisciplinary teamwork. The four subscales of the measure provide insight into the nature of such benefits. To validate the TDMQ research is required with a greater number of health care professionals and in other clinical fields.

Communication access in the library for individuals who use augmentative and alternative communication.

Libraries for All is a community-based program that aims to enhance communication access to the library for individuals who use augmentative and alternative communication (AAC), by providing resources and instruction. The goals are to (a) provide communication boards, (b) complete facilitator training, and (c) promote the program. To accomplish these goals, four communication boards were created and provided to all public libraries in London, Ontario. A train-the-trainer model was employed to ensure that all members of the library staff were familiar with the boards and aware of strategies to communicate more effectively with individuals who use AAC. Marketing materials were sent to potential stakeholders. The success of the program in meeting these three goals is highlighted.

AAC and community partnerships: the participation path to community inclusion.

The Life Needs Model (LNM) of service delivery emphasizes the importance of community participation in children's development and quality of life. This article is a case illustration of two community partnership programs based on the LNM. StoryTime and Dress Up and Drama provide participation opportunities in the community for children who use Augmentative and Alternative Communication (AAC). The authors describe the development and implementation of both programs. Regardless of level of functioning, each child who participated in the programs did so by communicating, interacting socially, and controlling the environment. Multiple benefits for children, parents/caregivers, community partners, and AAC clinicians are highlighted. The authors hope that this article will assist others in developing partnerships and implementing inclusive practices within their communities.

Dorsal simultanagnosia: An impairment of visual processing or visual awareness?

When presented with two objects patients with simultanagnosia show a marked impairment at naming both items. This has led many authors to conclude that the second item is not being processed (e.g., Robinson, 2003). However, this deficit may instead reflect a deficit with explicit, or conscious report. We investigated this issue using a semantic priming paradigm that allowed us to assess implicit processing of the second "unseen" item. We presented a patient, with bilateral parietal damage, with pairs of pictures that were either from the same or a different semantic category. The patient was asked to either classify one of the pictures or to name both pictures. When the items were from different categories the patient's classification performance was significantly poorer than when they were from the same category, even though he could rarely explicitly report both items. These findings are consistent with the notion that the meaning of the "unseen" item influenced the reporting of the "seen" item. Consequently, the deficit seen in this patient does not seem to reflect an inability to process more than one item simultaneously but rather a deficit in explicitly identifying multiple items.